Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India
Abstract Background Tuberculosis (TB) poses a significant social and economic burden to households of persons with TB (PwTB). Despite free diagnosis and care under the National TB Elimination Programme (NTEP), individuals often experience significant out-of-pocket expenditure and lost productivity,...
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2024-12-01
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| Online Access: | https://doi.org/10.1186/s41256-024-00392-9 |
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| author | Kathiresan Jeyashree Jeromie W. V. Thangaraj Devika Shanmugasundaram Sri Lakshmi Priya Giridharan Sumit Pandey Prema Shanmugasundaram Sabarinathan Ramasamy Venkateshprabhu Janagaraj Sivavallinathan Arunachalam Rahul Sharma Vaibhav Shah Bhavani Shankara Bagepally Joshua Chadwick Hemant Deepak Shewade Aniket Chowdhury Swati Iyer Raghuram Rao Sanjay K. Mattoo Manoj V. Murhekar |
| author_facet | Kathiresan Jeyashree Jeromie W. V. Thangaraj Devika Shanmugasundaram Sri Lakshmi Priya Giridharan Sumit Pandey Prema Shanmugasundaram Sabarinathan Ramasamy Venkateshprabhu Janagaraj Sivavallinathan Arunachalam Rahul Sharma Vaibhav Shah Bhavani Shankara Bagepally Joshua Chadwick Hemant Deepak Shewade Aniket Chowdhury Swati Iyer Raghuram Rao Sanjay K. Mattoo Manoj V. Murhekar |
| author_sort | Kathiresan Jeyashree |
| collection | DOAJ |
| description | Abstract Background Tuberculosis (TB) poses a significant social and economic burden to households of persons with TB (PwTB). Despite free diagnosis and care under the National TB Elimination Programme (NTEP), individuals often experience significant out-of-pocket expenditure and lost productivity, causing financial catastrophe. We estimated the costs incurred by the PwTB during TB care and identified the factors associated with the costs. Methods In our cross-sectional study, we used multi-stage sampling to select PwTB notified under the NTEP, whose treatment outcome was declared between May 2022 and February 2023. Total patient costs were measured through direct medical, non-medical and indirect costs. Catastrophic costs were defined as expenditure on TB care > 20% of the annual household income. We determined the factors influencing the total cost of TB care using median regression. We plotted concentration curves to depict the equity in distribution of catastrophic costs across income quintiles. We used a cluster-adjusted, generalized model to determine the factors associated with catastrophic costs. Results The mean (SD) age of the 1407 PwTB interviewed was 40.8 (16.8) years. Among them, 865 (61.5%) were male, and 786 (55.9%) were economically active. Thirty-four (2.4%) had Drug Resistant TB (DRTB), and 258 (18.3%) had been hospitalized for TB. The median (Interquartile range [IQR] and 95% confidence interval [CI]) of total costs of TB care was US$386.1 (130.8, 876.9). Direct costs accounted for 34% of the total costs, with a median of US$78.4 (43.3, 153.6), while indirect costs had a median of US$279.8 (18.9,699.4). PwTB < 60 years of age (US$446.1; 370.4, 521.8), without health insurance (US$464.2; 386.7, 541.6), and those hospitalized(US$900.4; 700.2, 1100.6) for TB experienced higher median costs. Catastrophic costs, experienced by 45% of PwTB, followed a pro-poor distribution. Hospitalized PwTB (adjusted prevalence ratio [aPR] = 1.9; 1.6, 2.2) and those notified from the private sector (aPR = 1.4; 1.1, 1.8) were more likely to incur catastrophic costs. Conclusions PwTB in India incur high costs mainly due to lost productivity and hospitalization. Nearly half of them experience catastrophic costs, especially those from poorer economic quintiles. Enabling early notification of TB, expanding the coverage of health insurance schemes to include PwTB, and implementing TB sensitive strategies to address social determinants of TB may significantly reduce catastrophic costs incurred by PwTB. |
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| institution | OA Journals |
| issn | 2397-0642 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
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| series | Global Health Research and Policy |
| spelling | doaj-art-00f5ce04b98f45e48a4a33ca4fb3ba102025-08-20T01:56:24ZengBMCGlobal Health Research and Policy2397-06422024-12-019111310.1186/s41256-024-00392-9Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in IndiaKathiresan Jeyashree0Jeromie W. V. Thangaraj1Devika Shanmugasundaram2Sri Lakshmi Priya Giridharan3Sumit Pandey4Prema Shanmugasundaram5Sabarinathan Ramasamy6Venkateshprabhu Janagaraj7Sivavallinathan Arunachalam8Rahul Sharma9Vaibhav Shah10Bhavani Shankara Bagepally11Joshua Chadwick12Hemant Deepak Shewade13Aniket Chowdhury14Swati Iyer15Raghuram Rao16Sanjay K. Mattoo17Manoj V. Murhekar18ICMR-National Institute of Epidemiology (ICMR-NIE)ICMR-National Institute of Epidemiology (ICMR-NIE)ICMR-National Institute of Epidemiology (ICMR-NIE)ICMR-National Institute of Epidemiology (ICMR-NIE)ICMR-National Institute of Epidemiology (ICMR-NIE)ICMR-National Institute of Epidemiology (ICMR-NIE)ICMR-National Institute of Epidemiology (ICMR-NIE)ICMR-National Institute of Epidemiology (ICMR-NIE)TB Support Network, WHO Country Office for IndiaTB Support Network, WHO Country Office for IndiaTB Support Network, WHO Country Office for IndiaICMR-National Institute of Epidemiology (ICMR-NIE)ICMR-National Institute of Epidemiology (ICMR-NIE)ICMR-National Institute of Epidemiology (ICMR-NIE)TB Support Network, WHO Country Office for IndiaTB Support Network, WHO Country Office for IndiaCentral TB DivisionCentral TB DivisionICMR-National Institute of Epidemiology (ICMR-NIE)Abstract Background Tuberculosis (TB) poses a significant social and economic burden to households of persons with TB (PwTB). Despite free diagnosis and care under the National TB Elimination Programme (NTEP), individuals often experience significant out-of-pocket expenditure and lost productivity, causing financial catastrophe. We estimated the costs incurred by the PwTB during TB care and identified the factors associated with the costs. Methods In our cross-sectional study, we used multi-stage sampling to select PwTB notified under the NTEP, whose treatment outcome was declared between May 2022 and February 2023. Total patient costs were measured through direct medical, non-medical and indirect costs. Catastrophic costs were defined as expenditure on TB care > 20% of the annual household income. We determined the factors influencing the total cost of TB care using median regression. We plotted concentration curves to depict the equity in distribution of catastrophic costs across income quintiles. We used a cluster-adjusted, generalized model to determine the factors associated with catastrophic costs. Results The mean (SD) age of the 1407 PwTB interviewed was 40.8 (16.8) years. Among them, 865 (61.5%) were male, and 786 (55.9%) were economically active. Thirty-four (2.4%) had Drug Resistant TB (DRTB), and 258 (18.3%) had been hospitalized for TB. The median (Interquartile range [IQR] and 95% confidence interval [CI]) of total costs of TB care was US$386.1 (130.8, 876.9). Direct costs accounted for 34% of the total costs, with a median of US$78.4 (43.3, 153.6), while indirect costs had a median of US$279.8 (18.9,699.4). PwTB < 60 years of age (US$446.1; 370.4, 521.8), without health insurance (US$464.2; 386.7, 541.6), and those hospitalized(US$900.4; 700.2, 1100.6) for TB experienced higher median costs. Catastrophic costs, experienced by 45% of PwTB, followed a pro-poor distribution. Hospitalized PwTB (adjusted prevalence ratio [aPR] = 1.9; 1.6, 2.2) and those notified from the private sector (aPR = 1.4; 1.1, 1.8) were more likely to incur catastrophic costs. Conclusions PwTB in India incur high costs mainly due to lost productivity and hospitalization. Nearly half of them experience catastrophic costs, especially those from poorer economic quintiles. Enabling early notification of TB, expanding the coverage of health insurance schemes to include PwTB, and implementing TB sensitive strategies to address social determinants of TB may significantly reduce catastrophic costs incurred by PwTB.https://doi.org/10.1186/s41256-024-00392-9Costs of TB careCatastrophic costsDirect costsIndirect costsIndia |
| spellingShingle | Kathiresan Jeyashree Jeromie W. V. Thangaraj Devika Shanmugasundaram Sri Lakshmi Priya Giridharan Sumit Pandey Prema Shanmugasundaram Sabarinathan Ramasamy Venkateshprabhu Janagaraj Sivavallinathan Arunachalam Rahul Sharma Vaibhav Shah Bhavani Shankara Bagepally Joshua Chadwick Hemant Deepak Shewade Aniket Chowdhury Swati Iyer Raghuram Rao Sanjay K. Mattoo Manoj V. Murhekar Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India Global Health Research and Policy Costs of TB care Catastrophic costs Direct costs Indirect costs India |
| title | Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India |
| title_full | Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India |
| title_fullStr | Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India |
| title_full_unstemmed | Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India |
| title_short | Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India |
| title_sort | cost of tb care and equity in distribution of catastrophic tb care costs across income quintiles in india |
| topic | Costs of TB care Catastrophic costs Direct costs Indirect costs India |
| url | https://doi.org/10.1186/s41256-024-00392-9 |
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